Definition

A surgical procedure to correct a foot deformity called a hammer toe . This deformity occurs when there is a shortening of the tendon that controls toe movement, causing the middle joint of the toe to be bent upward and the most distal joint downwards. This middle joint is also known as the proximal interphalangeal joint. The misshapen toe resembles a hammer.

Hammer toe

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Parts of the Body Involved

Any toe except the big toe

Reasons for Procedure

  • Failure of conservative therapy
  • The malformed toe has assumed an awkward position and is causing pain
  • The deformity makes walking difficult
  • The position of toe causes breakdown of skin, which can increase the risk of developing a bone infection (osteomyelitis)
  • Cosmetic appearance alone is not an indication for surgery

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • X-rays of joint

The day of the procedure:

  • Arrange for a ride to and from the procedure.
  • Arrange for help at home after the procedure.
  • Wear comfortable clothing that is easy to remove.

During Procedure

Anesthesia

Anesthesia

Usually local, but it could be a spinal

Description of the Procedure

Several surgical options are available for hammer toe, depending upon the individual condition. Sometimes hammer toe can be corrected with surgical procedures on the soft tissues, such as the tendons of the toes. This is usually best in patients under 30, with limited toe deformity. Two common methods of hammer toe correction involving surgery on the bones themselves are joint arthroplasty and joint fusion. The type of procedure used depends on the severity of the deformity, and a combination of procedures may be required.

Soft tissue procedures may involve the incision or release of a tendon, or reattaching a tendon in a way that corrects the deformity in the toe. For joint arthroplasty and joint fusion, the doctor does surgery on the bones. During an arthroplasty, the part of the bone on both sides of the middle joint of the toe may be removed, allowing the toe to uncurl. During a fusion, the bones are repositioned after ends of the bone at the joint are resected. The repositioning is usually held together with a pin placed within the bone, and this pin may be removed after 3 to 4 weeks. Other changes to the anatomy of the foot due to the hammer toe may also be corrected at this time, which may involve additional surgery.

The doctor may close the incision with stitches. These stitches will be removed in about two weeks, and the doctor will apply another dressing to hold the toe(s) in proper position. Dressings may be reapplied as swelling decreases, and can usually be totally removed after four weeks. If it appears that the deformity may recur, your doctor may choose to continue with dressings for another 2 to 4 weeks.

In people under age 30 with a mild deformity, a corrective procedure involving soft tissue (with no alteration to the joint or bones) may be possible.

After Procedure

A dressing will hold the repositioned toe in proper alignment.

How Long Will It Take?

This depends on the procedure and the number of toes corrected.

Will It Hurt?

Anesthesia prevents pain during the surgery

Possible Complications

  • Infection
  • Excessive swelling or bleeding, although the toe will normally be swollen for 4-8 weeks following surgery
  • Anesthesia-related problems
  • Recurrence of hammer toe
  • Loss of blood supply to the toe
  • Nerve injury involving the toe
  • For severe complications, toe amputation may be required

Average Hospital Stay

None

Postoperative Care

  • During the first couple of days, rest in bed with your foot elevated; only get out of bed to use the bathroom.
  • Keep your foot elevated while resting.
  • Limit standing and walking, and stay off your foot as much as possible.
  • Use crutches or wear a special open-toed, wooden-soled shoe, as directed by your doctor.

Outcome

The corrected toe may be slightly longer or shorter than before surgery (depending upon what has been done), and will not move as much as a normal toe. Expect some swelling and redness, which may persist for several months.

Select shoes with plenty of space for your toes. Poorly fitting shoes contribute to hammer toe development.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site